MEDICARE: RIDE4HEALTH DFW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1699340562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDE4HEALTH DFW

Provider Business Mailing Address
First Line	:	2510 COLUMBUS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76164-6968
Country	:	US
Telephone Number	:	214-396-9791
Fax Number	:	412-317-1570

Provider Business Practice Location Address
First Line	:	2510 COLUMBUS AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76164-6968
Country	:	US
Telephone Number	:	214-396-9791
Fax Number	:	412-317-1570

Authorized Official
Title or Position	:	COO
Name	:	JAMES C SMITH JR.
Credential	:
Telephone Number	:	814-934-2100

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	05/24/2021

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